A Pathophysiologically-Based Approach to the Treatment and Prevention of Mental Illness and Its Related Disorders

Abstract

Medication, psychotherapy, or both are the most common approaches to the treatment of psychiatric disorders. However, due to the high incidence, early onset, and chronicity of psychiatric symptoms, both medication and psychotherapy can be resource-intensive, yet there is little consensus about which should be applied to which clinical syndromes. This is a matter of increasing concern in light of the growing mental health crisis. Much of the problem stems from the lack of a precise psychophysiological explanation for psychiatric symptomatology, as it leaves clinicians without a clear target for treatment. However, an emerging hypothesis—one that identifies the fundamental vulnerability trait in psychiatric disorders—has the potential to help solve these problems. According to the Multi-Circuit Neuronal Hyperexcitability (MCNH) Hypothesis, psychiatric symptoms are driven by an abnormal elevation in the activity of the neural circuits with which they are associated. Particularly under the influence of stress, too many neurons fire for too long, resulting in circuit-specific symptoms, such as anxiety, depression, irritability, insomnia, inattention, apathy, and obsessional thinking. What hypothetically determines which circuits will be pathologically hyperactive at any point in time are the aberrant neuronal discharges that tend to occur spontaneously or in conjunction with willful cognitions and emotions when the neurological system is hyperexcitable. Clinical application of this hypothesis has the potential to guide which form of treatment would be most effective for which patient and to streamline the use of medications and other medical interventions because it illuminates a specific target for treatment. It also has the potential, for the first time in history, to prevent the development of psychiatric symptoms because the trait of neuronal hyperexcitability is highly modifiable and can be identified objectively by simply measuring one’s resting vital signs. Moreover, because the trait of neuronal hyperexcitability also appears to be at the root of a wide range of general medical conditions, such as diabetes, high blood pressure, cardiovascular disease, and cancer, the early detection and management of the trait could usher in history’s greatest campaign in the first against sickness and disease.